PSA response to consultation on regulating NHS managers

Regulating NHS Managers: balancing accountability and support

We have submitted our response to the Government’s consultation: Leading the NHS: proposals to regulate NHS managers

The call for regulation of NHS managers has accompanied multiple inquiries and reviews over several decades. But any action needs to be proportionate, targeted and based on a clear understanding of the problem being addressed. Crucially steps should be taken to enhance professional development as well as accountability. This is what PSA’s Chief Executive, Alan Clamp, outlined when he gave his evidence in January to the Thirlwall Inquiry 

Who do we mean by 'NHS managers'?

NHS managers come in all shapes and sizes – that is to say the term ‘NHS manager’ is all encompassing. Potentially referring to all sorts of roles from junior managers to non-executive board members. 

Where do they work?

NHS managers are also likely to work in various environments, including:

• hospitals
• GP practices 
• independent providers
• working under NHS contracts.

It is also a term that could include managers working in both clinical and non-clinical roles, and so on. Additionally, it will encompass managers who may already be subject to some form of statutory regulation.

Introducing regulation will involve deciding who is in and who is out – decisions which should be based on an understanding of the levels of unmanaged risk for these different roles.

What is the problem? 

The inquiries and reviews that have identified problems with NHS management have variously found issues with the standards of management, and the fact that there were limited ways of holding people in these roles accountable and preventing them from moving to other jobs in the NHS. Not all options for regulation will address both these issues or do so to the same extent.

The UK Government’s consultation sets out three options for regulation of NHS managers, each has merits and drawbacks. 

1. A statutory register could raise standards and provide a way of excluding people who have fallen far short, but can be relatively inflexible, and would take time to introduce. 
2. A barring model offers flexibility but would also require legislation and not contribute significantly to raising standards. 
3. Voluntary registration could quickly improve standards and protect patients but would not have the same statutory powers to exclude people from the workforce. That said, if registration became an NHS requirement for holding specific posts, assurance would be bolstered. We would also suggest that any voluntary register was also accredited by the PSA for independent assurance this provides. An accredited voluntary register could also be a staging post on the way to statutory regulation.

The consultation on the regulation of NHS managers is a very useful first step on the way to finding the right solution. We agree with the Government that our right-touch regulation principles should guide the selection of the most appropriate regulatory model. This approach should help to establish the nature and scale of unmanaged risks to identify effective regulatory measures. What is also clear is that any approach should be developed in partnership with the sector, managers, healthcare professionals, and patient groups.